kevro1013
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All Content by kevro1013
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We had a pt come in in status asthmaticus tonight. After her her hour long nebs and solumedrol ivp, she wasnt much better (RR=32 sat93% on RA). The ER MD ordered Mag sulfate 2 grams iv over 30 minutes. I had never heard of that as a treatment for AE of asthma before. I looked it up in the med book and sure enough under indications, there it was: relaxes smooth muscles in AE asthma. We gave it to her and she got better almost immediately! (I'm sure the solumedrol was also kicking in too). Learn something new every day! Kevin
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Great thread! Here is one I had last week. Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why? KevinI once took care of a guy who accidently shot himself in the right upper leg with a .25 pistol. He was in Babies 'R' Us buying his newborn grandson a corificeat. When he reached into his pocket to get exact change at the register, he pulled the trigger! It was only a fleshwound not requiring removal but I would have loved to see the clerk's reaction!If you attempt suicide by taking 200 assorted pills in front of your parole officer and you are brought to the ed to get lavaged, the sorbitol in the charcoal might give you explosive diarrhea. If this happens and you find yourself incontinent of stool, do not try to bite/hit/kick the nurse that tries to clean you up. You might just have to sit in your own stool all night. Sorry.Anyone else use fentanyl in the ED for acute pain? We currently use it for most cons. sedations (with versed). We have a Doc that orders it a lot for acute pain with an order like: Fent. 50-100mcg iv q 20 min prn. Most pts with this type of order are ortho types(good for getting x-rays done),chronic pain med pts, stable traumas etc. Just wondering... I like it b/c it seems less vasoactive and has less accumulative effects with multiple dosing r/t its short half life. KevinA nurse in our ER got written up by an ICU nurse because she did not weigh a pt before starting them on heparin. The pt was having an acute MI! The pt guestimated his weight @ 95kg, when they weighed him on the bed in the CCU he weighed 96.5kg. Our ER stretchers are 15 years old and they do NOT weigh pts. Also, the difference in weight did NOT change the heparin gtt or bolus dose. Uh, you want me to walk an acute MI to a scale to weigh him ? I'll take the write up over the v-tach.Actually, Bilateral BPs are a good idea when assessing for a AAA, greater than 20mm hg difference can be a significant finding.WOW! Really puts a new twist on pushing someone's buttons!You have been preparing to take the nclex since you took your first nursing exam in school (thats what instructors try to model questions after). I agree with the above posts; if you have been reviewing the material and are doing well on practice tests you will do well. Take the day before your exam off (study minimally) rest, eat a good breakfast, get a good nights sleep. Good Luck!!Great post! I must be a combo tool belt/joker (striving to be a good guy) would like to add: "The grass is greener nurse"- Sometimes an agency nurse sometimes not, always has a negative comment about this facility ie: "we never have hall patients @ blah blah facility and our ratio is Never > 3:1." Really? Why are you here then?It sounds like your facility is already ahead of the game! I must say though one of the most challenging type of pt in the ER from LTC is a chief complaint of altered mental status with no base line to compare to and also when the symptoms were noticed. A nurse to nurse report always helps before the transport (if possible since by the time the pt arrives the nurse who transfered the pt from ltc may be gone) and transfer forms are good at summing up basic data. (again sounds like you are on the ball here) On the other end I always try to call a nurse to nurse when the pt will be returning (or be admitted for an update). h&p is good if you can read it, emergency contacts for family are helpful, code status sheets are a necessity of course. I think it needs to be simple and spell everything out since the form is actually for another facility to read. Btw thanks for trying to make our job easier!Do not take left over medications out of the sharps boxes and mix them together and shoot them up in the employee bathroom of the ER you happen to work in. SOME of those medications MIGHT contain sedatives and vasoactives that MIGHT make your heart slow down so that you will pass out and drool on yourself.-This would categorize as one of the sickest things I've ever seen. This IV drug user had been shooting in the dorsal vein of his member (I'm not kidding). It had abcessed and swollen almost to the point that distal circulation was being compromised. OUCH!In our ED a nurse that had been an ED nurse for 45 years used to say 0 is no pain 10 is acid in your face....DNAR=do not attempt resuscitation; if the pt has a decline in condition do they not deserve medical treatment? DNR means not to "code" them- Withdrawling medical care totally from someone to let them die is hospice care* I agree if a pt is in LTC and a DNR and they stop breathing don't call EMS let them go for these were their wishes but to imply that they do not deserve an emergent transport for an emergent condition is wrong. I know people who are 25 with advanced directives. It depends on their wishes... Just my 2 measly cents..This is a very sensitve issue. Just my two measly cents. Did the Physician discuss these aspects of your care to you as well or only to your father in private? I understand you were in a great deal of pain and were to be medicated with narcs (both situations difficult to hold a conversation with on a serious topic) I would like to think the Doc discussed this with your father out of concern for you knowing that chronic pain sufferers are at high risk for addiction. ED staff (as myself ) sometimes become jaded in the day in day out routine of seeing addiction rear its ugly head and claim another victim. I am by no means calling you an drug seeker with only two visits to the ED for a legit cause. For there to be a hippa violation (IMHO), there must be a leak of info to someone you did not give permission to receive that info. Did your father know why you were there? Did you not want him to know what was going on? Maybe the MD thought you were in too much pain to discuss this at that time. We were encouraged in Nursing school to include the family in teaching and to focus on the family because the patient was usually too overwhelmed by the pain or medication to take notes on what we were trying to teach or express concern about. Was this the time and place (and person ) for this discussion? Probably not- After only two visits to the ED (for a legit cause) it was both unprofessional and inappropriate for them to discuss that with your father. I would have delt with it differently but thats just me! -Just my thoughts -Good luck!We have had many flooding our ED with "Flu" like symptoms: fever, cough, chills etc.. Many do not even take tylenol/advil at home for the fever-they just come in and c/o fever. I am trying to take the opportunity to educate about this (take tylenol q4 advil q6 atc) but to many it is like they are hearing it for the first time! I had someone ask me why the tylenol they took yesterday morning was not still working on their fever. (I guess the fever had their mental status altered!) Also had a lady screaming at a doc because he would not give her antibiotics and narcs for her "flu" (had to call security)In the facility where I work, NONE of the 4 units have a room 13. (12 then 14) However I work in the ED where in room 13 I had a spell over one month where we put in 4 ventriculostomies! (we maybe see one every other month) I can also remember most of the MI's that I have worked on being in that room, plus most of the OD's that get lavaged I can remember being in that same room ~13~. Spooky huh...Emtala requires that a pt receive a medical screening exam and receive appropriate treatment to be stabilized and rule out any emergency situation. Since the pt was discharged by the MD, the report to the receiving facility was a courtesy. At our ED, we will often DC a pt and send to a behaivioral health facility while calling report to the facility as a courtesy. If the pt is a 1009 (voluntary commital) or a hold (1013/2013) they must be a transfer according to our facility.Ditto to scis, also sounds like your triage area needs another RN- I know it gets harry out there- sounds like you need a break from triage- I know I do once in a while!I had a sweet lol (little old lady) once who had a pca pump and she kept dropping her administration button. When I went in to find it for her she said Where is my "SPICER UPPER"? Right here tied to you sweetie...Craig, Thanks for all of your insights, they have been entertaining, informative and inspiring. You are like that upperclassman in Nursing school who always told you what it will be like "next semester", what to expect, who to watch out for, and most importantly: to keep on going even when it is a tough go. Thank you for all your contributions to those of us aspiring to become srnas and crnas. Best of luck! Kevin